Article(id=1241035549994185583, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241035543589483182, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202405435, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1716825600000, receivedDateStr=2024-05-28, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773815532444, onlineDateStr=2026-03-18, pubDate=1735056000000, pubDateStr=2024-12-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773815532444, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773815532444, creator=13701087609, updateTime=1773815532444, updator=13701087609, issue=Issue{id=1241035543589483182, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='24', pageStart='4417', pageEnd='4608', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773815530917, creator=13701087609, updateTime=1773815686426, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241036195896029478, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241035543589483182, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241036195896029479, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241035543589483182, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=4567, endPage=4572, ext={EN=ArticleExt(id=1241035550484919179, articleId=1241035549994185583, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of HIV-1 genotypes and molecular transmission network among newly reported HIV/AIDS cases aged 50 and above in Yubei District of Chongqing, columnId=null, journalTitle=Modern Preventive Medicine, columnName=null, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the genotypes and characteristics of HIV-1 transmission network of newly reported HIV/AIDS cases aged 50 and above in Yubei District of Chongqing and provide evidence for effective HIV-1 transmission prevention in Yubei District.

Methods

Blood sample of newly reported cases aged 50 and above in 2020-2023 were collected for genetic analysis, partial Pol gene sequences were obtained to construct molecular transmission network. The factors associated with the subjects entering network and characteristics of cluster were further analyzed.

Results

A total of 351 Pol gene sequences were obtained and 9 HIV-1 genotypes were detected. CRF07_BC (57.0%, 200/351) was the major subtypes, followed by CRF08_BC(19.4%, 68/351), the rate of network entry was 57.3%, and 44 clusters were formed. The number of nodes in clusters was between 2-25. People aged 60 and above (60-69years old: aOR=2.25, 95% CI: 1.34-3.80; 70-79years old: aOR=2.93,95% CI: 1.52-5.65), with local household registration in Yubei (aOR=3.10, 95% CI: 1.74-5.52) and genotype CRF07_BC (aOR=2.57, 95% CI: 1.47-4.50) were more likely to have internet access. The proportion of high-risk spreaders was higher among males than among females.

Conclusion

CRF07_BC and CRF08_BC are the major genotypes of HIV/AIDS in people aged 50 years and abovein Yubei District, and CRF07_BC is the genotype of key transmission cluster with high transmission risk.We should strengthen the intervention for the high-risk elderly, and monitor the molecular network dynamically to guide the precise intervention.

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目的

分析重庆市渝北区新报告50岁及以上人群HIV-1基因型及分子传播网络特征,为该地区有效干预HIV传播提供科学参考依据。

方法

收集2022—2023年新报告的50岁及以上HIV/AIDS血液样本用于基因分析,通过计算Pol区基因距离构建分子网络,对研究对象进入网络的相关因素及成簇病例特征进行分析。

结果

获得351条Pol区基因序列,共检测出9种HIV-1基因型,CRF07_BC是最主要的传播亚型,占57.0%(200/351),其次为CRF08_BC占19.4%(68/351),共有201条序列进入网络,入网率为57.3%,形成44个簇,簇内的节点数介于2~25个之间。60岁及以上(60~69岁:aOR=2.25, 95% CI:1.34~3.80;70~79岁:aOR=2.93, 95% CI:1.52~5.65)、渝北本地户籍(aOR=3.10, 95% CI:1.74~5.52)、基因型为CRF07_BC(aOR=2.57, 95% CI:1.47~4.50)更容易入网。高风险传播者在男性中的比例高于女性。

结论

渝北区新报告50岁及以上HIV/AIDS的HIV-1基因型以CRF07_BC、CRF08_BC为主,传播风险较高的重点传播簇基因型为CRF07_BC,应针对老年人高风险者加强干预,动态监测分子网络,指导精准干预。

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刘惠,E-mail:
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刘惠(1983—),女,硕士,副主任医师,研究方向:艾滋病防治工作

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(In Chinese), articleTitle=Analysis of sex ratio of newly reportedpeople living with HIV/AIDS aged ≥ 50 years and infected through heterosexual contact in China,2015-2019, refAbstract=null), Reference(id=1241069998999925684, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035549994185583, doi=null, pmid=null, pmcid=null, year=2023, volume=29, issue=6, pageStart=477, pageEnd=480, url=null, language=null, rfNumber=[20], rfOrder=33, authorNames=林焕年, journalName=预防医学论坛, refType=null, unstructuredReference=林焕年.我国西部地区中老年HIV/AIDS病例流行特点、危险因素与防控策略的研究进展[J].预防医学论坛, 2023, 29(6): 477-480., articleTitle=我国西部地区中老年HIV/AIDS病例流行特点、危险因素与防控策略的研究进展, refAbstract=null), Reference(id=1241069999108977592, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035549994185583, doi=null, pmid=null, pmcid=null, year=2023, volume=29, issue=6, pageStart=477, pageEnd=480, url=null, language=null, rfNumber=[20], rfOrder=34, authorNames=Lin HN, journalName=Preventive Medicine Tribune, refType=null, unstructuredReference=Lin HN. Research progress on the epidemiological characteristics, risk factors and prevention and control strategies of middle-aged and elderly HIV/AIDS cases in the western region of China[J]. Preventive Medicine Tribune, 2023, 29(6): 477-480. (In Chinese), articleTitle=Research progress on the epidemiological characteristics, risk factors and prevention and control strategies of middle-aged and elderly HIV/AIDS cases in the western region of China, refAbstract=null)], funds=[Fund(id=1241069993803182834, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035549994185583, awardId=2023YBKW13, language=CN, fundingSource=2023年重庆市公共卫生重点专科(学科)建设项目,重庆市渝北区科卫联合项目(2023YBKW13), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241069986035331409, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035549994185583, xref=null, ext=[AuthorCompanyExt(id=1241069986060497235, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035549994185583, companyId=1241069986035331409, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Chongqing Yubei District Center for Disease Control and Prevention, Chongqing 401120, China), AuthorCompanyExt(id=1241069986077274453, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035549994185583, companyId=1241069986035331409, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=重庆市渝北区疾病预防控制中心,重庆 401120)])], figs=[ArticleFig(id=1241069990762312321, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035549994185583, language=EN, label=Fig.1, caption=Hiv-1 molecular transmission network map in the newly reported population aged 50 and above inYubei District from 2022 to 2023, figureFileSmall=MkpoAJOLJzEiIeN9XOWw/A==, figureFileBig=AHXvSmGkKFxKOYE5CirKlw==, tableContent=null), ArticleFig(id=1241069990888141450, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035549994185583, language=CN, label=图1, caption=渝北区2022-2023年新报告50岁及以上人群HIV-1分子传播网络图, figureFileSmall=MkpoAJOLJzEiIeN9XOWw/A==, figureFileBig=AHXvSmGkKFxKOYE5CirKlw==, tableContent=null), ArticleFig(id=1241069991102050970, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035549994185583, language=EN, label=Table 1, caption=

Basic characteristics and genotype distribution of HIV/AIDS in the newly reported population aged 50 and above inYubei District from 2022 to 2023

, figureFileSmall=null, figureFileBig=null, tableContent=
基本特征研究对象
n=351)
CRF07_BC
n(%)]
CRF08_BC
n(%)]
其他
n(%)]
χ2P
性别0.0750.963
225127(56.4)44(19.6)54(24.0)
12673(57.9)24(19.0)29(23.0)
年龄组(岁)7.7560.257
50~5914687(59.6)29(19.9)30(20.5)
60~6912475(60.5)21(16.9)28(22.6)
70~796833(48.5)13(19.1)22(32.4)
≧80135(38.5)5(38.5)3(23.1)
户籍地1.7090.789
渝北区258143(55.4)45(62.5)12(57.1)
其他区县7250(19.4)14(19.4)4(19.0)
市外2165(25.2)13(18.1)5(23.8)
职业6.3330.176
家务及待业14978(52.3)36(24.2)35(23.5)
农民12176(62.8)15(12.4)30(24.8)
其他8146(56.8)17(21.0)18(22.2)
婚姻状况8.9910.061
已婚217130(59.9)46(21.2)41(18.9)
离异或丧偶10352(50.5)16(15.5)35(34.0)
未婚3118(58.1)6(19.4)7(22.6)
文化程度1.4670.480
小学及以下245135(55.1)48(19.6)62(25.3)
初中及以上10665(61.3)20(18.9)21(19.8)
感染途径2.4000.328a
异性传播341193(56.6)68(19.9)80(23.5)
同性传播107(70.0)03(30.0)
首次CD4(个/μl)7.3540.289
<20016991(53.8)30(17.8)48(28.4)
200~34911970(58.8)24(20.2)25(21.0)
350~4994022(55.0)11(27.5)7(17.5)
≥5002317(73.9)3(13.0)3(13.0)
), ArticleFig(id=1241069991194325666, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035549994185583, language=CN, label=表1, caption=

2022—2023年渝北区新报告50岁及以上人群HIV/AIDS的基本特征和基因型分布

, figureFileSmall=null, figureFileBig=null, tableContent=
基本特征研究对象
n=351)
CRF07_BC
n(%)]
CRF08_BC
n(%)]
其他
n(%)]
χ2P
性别0.0750.963
225127(56.4)44(19.6)54(24.0)
12673(57.9)24(19.0)29(23.0)
年龄组(岁)7.7560.257
50~5914687(59.6)29(19.9)30(20.5)
60~6912475(60.5)21(16.9)28(22.6)
70~796833(48.5)13(19.1)22(32.4)
≧80135(38.5)5(38.5)3(23.1)
户籍地1.7090.789
渝北区258143(55.4)45(62.5)12(57.1)
其他区县7250(19.4)14(19.4)4(19.0)
市外2165(25.2)13(18.1)5(23.8)
职业6.3330.176
家务及待业14978(52.3)36(24.2)35(23.5)
农民12176(62.8)15(12.4)30(24.8)
其他8146(56.8)17(21.0)18(22.2)
婚姻状况8.9910.061
已婚217130(59.9)46(21.2)41(18.9)
离异或丧偶10352(50.5)16(15.5)35(34.0)
未婚3118(58.1)6(19.4)7(22.6)
文化程度1.4670.480
小学及以下245135(55.1)48(19.6)62(25.3)
初中及以上10665(61.3)20(18.9)21(19.8)
感染途径2.4000.328a
异性传播341193(56.6)68(19.9)80(23.5)
同性传播107(70.0)03(30.0)
首次CD4(个/μl)7.3540.289
<20016991(53.8)30(17.8)48(28.4)
200~34911970(58.8)24(20.2)25(21.0)
350~4994022(55.0)11(27.5)7(17.5)
≥5002317(73.9)3(13.0)3(13.0)
), ArticleFig(id=1241069991408235187, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035549994185583, language=EN, label=Table 2, caption=

Single factor analysis of influencing HIV-1 network access among newly reported population aged 50 and above inYubei District from 2022 to 2023

, figureFileSmall=null, figureFileBig=null, tableContent=
基本特征纳入研究对象(n=370)进入网络[n(%)]单因素logistic ORP
性别
225131(58.2)1.12(0.72~1.73)0.628
12670(55.6)1
年龄组
50~5914666(45.2)10.001
60~6912478(62.9)2.06(1.26~3.35)0.004
70~796848(70.6)2.91(1.57~5.38)0.001
≧80139(69.2)2.73(0.80~9.26)0.108
户籍地
渝北区258163(63.2)2.86(1.67~4.91)<0.001
其他区县7227(37.5)10.001
市外2111(52.4)1.83(0.69~4.89)0.226
职业
家务及待业14985(57.0)1.36(0.79~2.34)0.266
农民12176(62.8)1.73(0.98~3.06)0.059
其他8140(49.4)10.169
婚姻状况
未婚3119(61.3)1.49(0.66~3.39)0.337
已婚217129(59.4)1.38(0.86~2.22)0.178
离异或丧偶10353(51.5)10.361
文化程度
小学及以下245148(60.4)1.53(0.96~2.41)0.071
初中及以上10653(50.0)1
感染途径
异性传播341201(58.9)--
同性传播100--
首次CD4(个/μl)
<20016993(55.0)10.787
200~34911972(60.5)1.25(0.78~2.02)0.355
350~4994022(55.0)1.00(0.50~2.00)0.997
≥5002314(60.9)1.27(0.52~3.10)0.597
基因型
CRF07_BC200125(62.5)1.97(1.18~3.31)0.010
CRF08_BC6838(55.9)1.50(0.79~2.86)0.218
其他8338(45.8)10.036
), ArticleFig(id=1241069991542452920, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035549994185583, language=CN, label=表2, caption=

渝北区2022—2023年新报告50岁及以上人群HIV-1入网影响单因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
基本特征纳入研究对象(n=370)进入网络[n(%)]单因素logistic ORP
性别
225131(58.2)1.12(0.72~1.73)0.628
12670(55.6)1
年龄组
50~5914666(45.2)10.001
60~6912478(62.9)2.06(1.26~3.35)0.004
70~796848(70.6)2.91(1.57~5.38)0.001
≧80139(69.2)2.73(0.80~9.26)0.108
户籍地
渝北区258163(63.2)2.86(1.67~4.91)<0.001
其他区县7227(37.5)10.001
市外2111(52.4)1.83(0.69~4.89)0.226
职业
家务及待业14985(57.0)1.36(0.79~2.34)0.266
农民12176(62.8)1.73(0.98~3.06)0.059
其他8140(49.4)10.169
婚姻状况
未婚3119(61.3)1.49(0.66~3.39)0.337
已婚217129(59.4)1.38(0.86~2.22)0.178
离异或丧偶10353(51.5)10.361
文化程度
小学及以下245148(60.4)1.53(0.96~2.41)0.071
初中及以上10653(50.0)1
感染途径
异性传播341201(58.9)--
同性传播100--
首次CD4(个/μl)
<20016993(55.0)10.787
200~34911972(60.5)1.25(0.78~2.02)0.355
350~4994022(55.0)1.00(0.50~2.00)0.997
≥5002314(60.9)1.27(0.52~3.10)0.597
基因型
CRF07_BC200125(62.5)1.97(1.18~3.31)0.010
CRF08_BC6838(55.9)1.50(0.79~2.86)0.218
其他8338(45.8)10.036
), ArticleFig(id=1241069991638921918, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035549994185583, language=EN, label=Table 3, caption=

Multi factor analysis of variables and assignment of influencing HIV-1 network access among newly reported population aged 50 and over inYubei District from 2022 to 2023

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值情况
年龄(岁)50~59岁赋值为1, 60~69岁赋值为2,70~79岁赋值为3,80~89岁赋值为4
户籍地其他区县户籍赋值为1,渝北区户籍赋值为2,市外户籍赋值为3
基因型其他基因型赋值为1,CRF07_BC基因型赋值为2,CRF08_BC基因型赋值为3
), ArticleFig(id=1241069991735390916, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035549994185583, language=CN, label=表3, caption=

渝北区2022—2023年新报告50岁及以上人群HIV-1入网影响多因素分析变量及赋值情况

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值情况
年龄(岁)50~59岁赋值为1, 60~69岁赋值为2,70~79岁赋值为3,80~89岁赋值为4
户籍地其他区县户籍赋值为1,渝北区户籍赋值为2,市外户籍赋值为3
基因型其他基因型赋值为1,CRF07_BC基因型赋值为2,CRF08_BC基因型赋值为3
), ArticleFig(id=1241069991869608650, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035549994185583, language=EN, label=Table 4, caption=

Multi factor analysis of influencing HIV-1 network access among newly reported population aged 50 and over inYubei District from 2022 to 2023

, figureFileSmall=null, figureFileBig=null, tableContent=
基本特征纳入研究对象(n=370)进入网络[n(%)]多因素logistic(aOR值)P
年龄组
50~5914666(45.2)10.002
60~6912478(62.9)2.25(1.34-3.80)0.002
70~806848(70.6)2.93(1.52-5.65)0.001
≥80139(69.2)3.01(0.82-11.02)0.097
户籍地
渝北区258163(63.2)3.10(1.74-5.52)<0.001
其他区县7227(37.5)10.001
市外2111(52.4)2.30(0.83-6.39)0.109
基因型
CRF07_BC200125(62.5)2.57(1.47-4.50)0.001
CRF08_BC6838(55.9)1.82(0.91-3.61)0.089
其他8338(45.8)10.004
), ArticleFig(id=1241069991974466257, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035549994185583, language=CN, label=表4, caption=

渝北区2022—2023年新报告50岁及以上人群HIV-1入网影响多因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
基本特征纳入研究对象(n=370)进入网络[n(%)]多因素logistic(aOR值)P
年龄组
50~5914666(45.2)10.002
60~6912478(62.9)2.25(1.34-3.80)0.002
70~806848(70.6)2.93(1.52-5.65)0.001
≥80139(69.2)3.01(0.82-11.02)0.097
户籍地
渝北区258163(63.2)3.10(1.74-5.52)<0.001
其他区县7227(37.5)10.001
市外2111(52.4)2.30(0.83-6.39)0.109
基因型
CRF07_BC200125(62.5)2.57(1.47-4.50)0.001
CRF08_BC6838(55.9)1.82(0.91-3.61)0.089
其他8338(45.8)10.004
), ArticleFig(id=1241069992075129559, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035549994185583, language=EN, label=Table 5, caption=

Distribution of newly reported HIV-1 cases with a connecting edge ≥ 4 among individuals aged 50 and above in Yubei District from 2022 to 2023

, figureFileSmall=null, figureFileBig=null, tableContent=
基本特征入网研究对象
(n=201)
连接边≥4病例
n(%)]
χ2P
性别4.3760.036
13167(51.1)
7025(35.7)
年龄组1.0160.797
50~596629(43.9)
60~697834(43.6)
70~794825(52.1)
≧8094(44.4)
户籍地1.2190.544
渝北区16378(47.9)
其他区县2710(37.0)
市外114(36.4)
职业2.1520.341
家务及待业8541(48.2)
农民7630(39.5)
其他4021(52.5)
婚姻状况0.6810.712
已婚12960(46.5)
离异或丧偶5325(47.2)
未婚197(36.8)
文化程度0.1640.686
小学及以下14869(46.6)
初中及以上5323(43.4)
首次CD4(个/μl)2.0830.555
<2009345(48.4)
200~3497233(45.8)
350~499227(31.8)
≥500147(50.0)
基因型0.0570.972
CRF07_BC12557(45.6)
CRF08_BC3818(47.4)
其他3817(44.7)
), ArticleFig(id=1241069993597661917, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035549994185583, language=CN, label=表5, caption=

渝北区2022—2023年新报告50岁及以上人群HIV-1连接边≥4病例分布

, figureFileSmall=null, figureFileBig=null, tableContent=
基本特征入网研究对象
(n=201)
连接边≥4病例
n(%)]
χ2P
性别4.3760.036
13167(51.1)
7025(35.7)
年龄组1.0160.797
50~596629(43.9)
60~697834(43.6)
70~794825(52.1)
≧8094(44.4)
户籍地1.2190.544
渝北区16378(47.9)
其他区县2710(37.0)
市外114(36.4)
职业2.1520.341
家务及待业8541(48.2)
农民7630(39.5)
其他4021(52.5)
婚姻状况0.6810.712
已婚12960(46.5)
离异或丧偶5325(47.2)
未婚197(36.8)
文化程度0.1640.686
小学及以下14869(46.6)
初中及以上5323(43.4)
首次CD4(个/μl)2.0830.555
<2009345(48.4)
200~3497233(45.8)
350~499227(31.8)
≥500147(50.0)
基因型0.0570.972
CRF07_BC12557(45.6)
CRF08_BC3818(47.4)
其他3817(44.7)
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重庆市渝北区新报告50岁及以上人群HIV-1基因型及分子传播网络特征分析
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刘惠 , 李荻菲 , 黄歆 , 叶茂 , 孙松松
现代预防医学 | 疾病预防控制 2024,51(24): 4567-4572
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现代预防医学 | 疾病预防控制 2024, 51(24): 4567-4572
重庆市渝北区新报告50岁及以上人群HIV-1基因型及分子传播网络特征分析
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刘惠 , 李荻菲, 黄歆, 叶茂, 孙松松
作者信息
  • 重庆市渝北区疾病预防控制中心,重庆 401120
  • 刘惠(1983—),女,硕士,副主任医师,研究方向:艾滋病防治工作

通讯作者:

刘惠,E-mail:
Analysis of HIV-1 genotypes and molecular transmission network among newly reported HIV/AIDS cases aged 50 and above in Yubei District of Chongqing
Hui LIU , Di-fei LI, Xin HUANG, Mao YE, Song-song SUN
Affiliations
  • Chongqing Yubei District Center for Disease Control and Prevention, Chongqing 401120, China
出版时间: 2024-12-25 doi: 10.20043/j.cnki.MPM.202405435
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目的

分析重庆市渝北区新报告50岁及以上人群HIV-1基因型及分子传播网络特征,为该地区有效干预HIV传播提供科学参考依据。

方法

收集2022—2023年新报告的50岁及以上HIV/AIDS血液样本用于基因分析,通过计算Pol区基因距离构建分子网络,对研究对象进入网络的相关因素及成簇病例特征进行分析。

结果

获得351条Pol区基因序列,共检测出9种HIV-1基因型,CRF07_BC是最主要的传播亚型,占57.0%(200/351),其次为CRF08_BC占19.4%(68/351),共有201条序列进入网络,入网率为57.3%,形成44个簇,簇内的节点数介于2~25个之间。60岁及以上(60~69岁:aOR=2.25, 95% CI:1.34~3.80;70~79岁:aOR=2.93, 95% CI:1.52~5.65)、渝北本地户籍(aOR=3.10, 95% CI:1.74~5.52)、基因型为CRF07_BC(aOR=2.57, 95% CI:1.47~4.50)更容易入网。高风险传播者在男性中的比例高于女性。

结论

渝北区新报告50岁及以上HIV/AIDS的HIV-1基因型以CRF07_BC、CRF08_BC为主,传播风险较高的重点传播簇基因型为CRF07_BC,应针对老年人高风险者加强干预,动态监测分子网络,指导精准干预。

50岁及以上人群  /  艾滋病病毒  /  基因型  /  分子传播网络
Objective

To analyze the genotypes and characteristics of HIV-1 transmission network of newly reported HIV/AIDS cases aged 50 and above in Yubei District of Chongqing and provide evidence for effective HIV-1 transmission prevention in Yubei District.

Methods

Blood sample of newly reported cases aged 50 and above in 2020-2023 were collected for genetic analysis, partial Pol gene sequences were obtained to construct molecular transmission network. The factors associated with the subjects entering network and characteristics of cluster were further analyzed.

Results

A total of 351 Pol gene sequences were obtained and 9 HIV-1 genotypes were detected. CRF07_BC (57.0%, 200/351) was the major subtypes, followed by CRF08_BC(19.4%, 68/351), the rate of network entry was 57.3%, and 44 clusters were formed. The number of nodes in clusters was between 2-25. People aged 60 and above (60-69years old: aOR=2.25, 95% CI: 1.34-3.80; 70-79years old: aOR=2.93,95% CI: 1.52-5.65), with local household registration in Yubei (aOR=3.10, 95% CI: 1.74-5.52) and genotype CRF07_BC (aOR=2.57, 95% CI: 1.47-4.50) were more likely to have internet access. The proportion of high-risk spreaders was higher among males than among females.

Conclusion

CRF07_BC and CRF08_BC are the major genotypes of HIV/AIDS in people aged 50 years and abovein Yubei District, and CRF07_BC is the genotype of key transmission cluster with high transmission risk.We should strengthen the intervention for the high-risk elderly, and monitor the molecular network dynamically to guide the precise intervention.

Aged 50 and above  /  HIV-1  /  Genotype  /  Molecular transmission network
刘惠, 李荻菲, 黄歆, 叶茂, 孙松松. 重庆市渝北区新报告50岁及以上人群HIV-1基因型及分子传播网络特征分析. 现代预防医学, 2024 , 51 (24) : 4567 -4572 . DOI: 10.20043/j.cnki.MPM.202405435
Hui LIU, Di-fei LI, Xin HUANG, Mao YE, Song-song SUN. Analysis of HIV-1 genotypes and molecular transmission network among newly reported HIV/AIDS cases aged 50 and above in Yubei District of Chongqing[J]. Modern Preventive Medicine, 2024 , 51 (24) : 4567 -4572 . DOI: 10.20043/j.cnki.MPM.202405435
近年来,我国艾滋病老年感染者和病人(HIV/AIDS)明显增高[1],病例报告数逐年增加[2],50岁及以上人群病例占比从2011年的22.0%上升到2020年的44.0%,中老年人HIV感染问题日益突出,成为艾滋病疫情的新特点[3]。渝北区50岁及以上人群病例数占新报告病例数的比例逐年上升。近年来,HIV-1分子传播网络分析已被广泛应用于国内外艾滋病防制中[4-5],对指导遏制艾滋病蔓延具有较大的公共卫生学意义。本研究选取重庆市渝北区新报告50岁及以上HIV/AIDS病例作为研究对象,通过现场流行病学结合分子流行病学特点,分析该人群流行毒株和HIV分子传播特征,为该地区针对50岁及以上人群制定有效减少HIV传播的防控措施提供参考依据。
选择2022年1月至2023年12月重庆市渝北区新报告50岁及以上HIV/AIDS人群作为研究对象。纳入标准包括:年龄≥50岁、未开展抗病毒治疗、签署知情同意书;排除标准包括:既往报告过的重复病例;不愿配合相关调查。收集的基本信息包括:性别、年龄、户籍地、现住址、职业、婚姻状况、文化程度、感染途径和基线CD4+ T淋巴细胞水平(CD4+ T淋巴细胞水平为开展抗病毒治疗前的最后一次检测结果)等。
使用10 mL EDTA抗凝管采集研究对象全血,分离出1 mL用于CD4+ T淋巴细胞水平检测,其余部分6小时内离心,分离出的血浆于-80 ℃冰箱保存,用于提取HIV RNA。
使用德国Qiagen公司生产的QIAamP Viral RNA Mini Kit提取HIV-1 RNA。使用宝日医生物技术(北京)有限公司生产的TaKaRa One SteP RNA PCR Kit (AMV)对Pol基因区的部分片段(HXB2:2147-3462)进行逆转录和第一轮聚合酶链式反应(Polymerase chain reaction, PCR),使用北京天根公司生产的2×Taq PCR Mix进行第二轮PCR。扩增成功的样本由北京博迈德基因技术有限公司进行纯化和测序。
使用Sequencher 5.4.6对获得的测序片段进行拼接,拼接完成的序列通过Bioedit 7.0进行比对和编辑。使用在线软件REGA HIV-1 SubtyPing Tool 3.0(http://dbPartners.stanford.edu:8080/RegaSubtyPing/stanford-hiv/tyPingtool/)和Comet HIV-1 (http://comet.retrovirology.lu)进行基因型判定,对于不确定的样本使用Basic Local Alignment Search Tool (http://blast.ncbi.nlm.nih.gov)比对后判定。
使用HyPhy 2.2.4软件在Tamura-Nei 93 (TN93)模型下计算序列间的基因距离。在0.1%~2%之间选择成簇最多的基因距离作为阈值[6]。使用CytoscaPe 3.7.1实现分子网络的可视化。
使用Excel 2016对资料进行整理,使用SPSS 22.0软件进行统计分析。采用单因素及多因素logistic回归模型分析入网率的影响因素,分类资料采用χ2检验。采用双侧检验,检验水准为α=0.05。
共有390例HIV/AIDS纳入本次研究,获取到其中351例的HIV Pol基因区序列。获取到序列的351例研究对象以男性(225,64.1%)、50-59岁(146,76.9%)、家务及待业(149,42.5%)、已婚有配偶(217,61.8%)、汉族(345,98.3%)、小学及以下文化程度(245,69.8%)、异性性传播(341,97.2%)、户籍地为渝北区(258,73.5%)的人群为主,CD4+T淋巴细胞计数以200个/μl (182,51.9%)为主。
在获得序列的351例研究对象中,共检出9种基因型。其中CRF07_BC占57.0%(200/351),CRF08_BC占19.4%(68/351), CRF01_AE占10.5%(37/351), CRF85_BC占8.0%(28/351),C亚型占2.0%(7/351),CRF55_01B占0.3%(1/351),URF占2.8%(10/351)。3种URF中,CRF01_AE/07_BC、BC、CRF01_AE/C分别为6例、3例和1例。各基因型在不同性别、年龄组、职业、文化程度、户籍地、婚姻状况、感染途径和首次CD4+T淋巴细胞水平的分布上没有统计学差异。见表1
当基因距离为1.2%时,形成的传播簇最多,共有201条序列进入网络,入网率为57.3%,累计形成44个簇,每个簇的个体数介于2~25之间。进入网络的基因型以CRF07_BC、CRF08_BC和CRF85_BC为主,分别占62.2%(125/201)、18.9%(38/201)和12.4%(25/201),见图1。将单因素分析有统计学意义的入网相关因素纳入多因素logistic回归分析,结果显示年龄、户籍地和基因型为进入网络的相关因素。相较于50~59岁年龄组,60~69岁及70~79岁年龄组的HIV/AIDS更容易进入网络(60~:aOR=2.25, 95% CI:1.34~3.80;70~:aOR=2.93, 95% CI:1.52~5.65);相较于其他区县,户籍地为渝北的HIV/AIDS更容易进入网络(aOR=3.10, 95% CI:1.74~5.52);相较于其他基因型,CRF07_BC更容易进入网络(aOR=2.57, 95% CI:1.47~4.50)。见表2-4
《HIV传播网络监测和干预技术指南(2021试行版)》要求重点关注连接边值3以上的网络,本研究共有92例连接边≥4,占比为45.8%,全部为异性传播,84.78%(78/92)为本区病例,主要分布于双龙湖街道、龙兴、古路、石船、统景、大盛镇等6个镇街,占本区内病例的55.13%(43/78)。市外连接边≥4的病例主要来自于与我区相邻的四川省达州市和广安市。78例本地病例中男性62例,96.77%(60/62)的男性传播途径为商业性行为,女性16例,50%(8/16)的女性为配偶阳性,男性中的比例高于女性(P<0.05),见表5。本研究发现重点传播簇存在地区聚集性,CRF07_BC有两个重点传播簇,A1簇共20例,主要聚集在古路、统景、大盛这三个相邻的乡镇共13例,A2簇共16例,其中11例聚集在龙兴镇,其中1名女性有商业性行为服务史;CRF07_BC中B1簇有7例,全部来自于洛碛镇。见图1
本次研究发现,渝北区新报告50岁及以上人群HIV-1基因型以CRF07_BC、CRF08_BC和CRF01_AE为主,这与国内部分地区的HIV-1基因型分布情况类似[7-8],也与渝北区全人群HIV-1基因型一致[9],CRF07_BC占比高于其他基因型,与重庆市之前开展的调查结果相同[10-11],但50岁及以上年龄组CRF08_BC比例要高于全人群比例。研究显示,CRF07_BC 和CRF08_BC 具有共同的重组祖先毒株,最初均是从静脉吸毒人群(IDU)中被发现,随着社会的变迁已通过性传播途径在普通人群中流行[12],与本次纳入病例全部为性传播途径感染相印证。
分子传播网络中,入网率越高,表明聚集性越强,传播风险也越高[13],本次研究入网率为57.3%,高于浙江省绍兴市50岁以上人群入网率[14],影响研究对象入网的因素是年龄在60岁以上,渝北区本地户籍,可能与我区近年来实施扩大检测策略有关,2023年我区结合基本公共卫生服务项目为65岁以上老年人提供HIV检测20余万人次,发现较多的老年本地户籍病例。入网率较高的基因型为CRF07_BC,与安徽阜阳的研究基本一致[15],提示老年人经性传播感染并传播的风险较大。本地区老年人群文化程度以小学为主,普遍偏低,接受艾滋病知识匮乏[16-17],极易发生高危性行为,亟需针对该人群开展干预,强化宣传教育,提高中老年人防病意识。
在分子传播簇中,节点的度值可以反映出个体的传播风险,度值越高,传播风险越大。本研究中连接边≥4者的本区域老年病例占比为84.78%,以男性为主(79.49%),主要分布在龙兴等6个镇街(55.13%),96%以上的老年男性都有商业性行为史,龙兴镇还发现1名女性从事商业性行为服务,说明本地区老年病例可能存在较高的传播风险,这与宁波市、泸州市的情况相似[14,18],研究表明老年男性在性需求无法得到满足的情况下会寻求高危的商业性行为,由于其消费地点通常为低档的性交易场所,从而导致了HIV聚集性传播,这可能是重点传播簇中老年男性比例较高的原因。提示我们要针对老年男性常出入的低档性交易场所,尤其是针对龙兴、洛碛、古路等老年病例聚集的重点镇街联合公安部门开展卖淫嫖娼打击,强化宣传尤其是安全套使用推广杜绝不安全性行为。50%老年女性为配偶阳性,亟需针对老年女性配偶阳性问题加强单阳家庭管理[19],做好配偶/固定性伴告知与检测工作[18],强化艾滋病感染者/病人的告知义务,进而遏制中老年人群艾滋病经性传播[20]。另外我们也发现部分病例来自于临近的四川省,可能与病例流动性有关,也提示川渝地区强化流动艾滋病病毒感染者协同管理服务的必要性。
为本研究不足之处,纳入的病例为新报告而非新感染病例,同时研究对象也纳入一定比例首次CD4小于200的病例,对传播簇的分析有一定的影响。
综上所述,2022至2023年重庆市渝北区新报告50岁以上人群的HIV/AIDS基因型以CRF07_BC、CRF08_BC和CRF01_AE 为主,传播风险较高重点传播簇基因型为CRF07_BC,在今后的防控工作中,应针对重点镇街重点人群加强干预,在此基础上动态开展分子网络监测,并指导精准干预。
  • 2023年重庆市公共卫生重点专科(学科)建设项目,重庆市渝北区科卫联合项目(2023YBKW13)
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2024年第51卷第24期
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doi: 10.20043/j.cnki.MPM.202405435
  • 接收时间:2024-05-28
  • 首发时间:2026-03-18
  • 出版时间:2024-12-25
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  • 收稿日期:2024-05-28
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2023年重庆市公共卫生重点专科(学科)建设项目,重庆市渝北区科卫联合项目(2023YBKW13)
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    重庆市渝北区疾病预防控制中心,重庆 401120

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Percentage of
total species (%)

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Number of
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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